Provider Demographics
NPI:1275030629
Name:BURCHETT, DIANA THERESA (APRN)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:THERESA
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11823 TETRAFIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4128
Mailing Address - Country:US
Mailing Address - Phone:813-954-0363
Mailing Address - Fax:813-644-5745
Practice Address - Street 1:11823 TETRAFIN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4128
Practice Address - Country:US
Practice Address - Phone:813-954-0363
Practice Address - Fax:813-644-5745
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9234499363LF0000X
FLARNP9234499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily